Metronidazole, 2 g orally, single or divided dose on the same day Routine treatment of sex partners is not recommended unless the partner is symptomatic Oral fluconazole (100 mg, 150 mg, or 200 mg) weekly for six months consider topical treatment if oral is not feasible Topical azole therapy for seven to 14 daysįluconazole, 150 mg orally every third day for three doses Topical azole therapy applied intravaginally for seven days Routine treatment of sex partners is not recommendedįluconazole (Diflucan), 150 mg orally, single dose Metronidazole 0.75% gel, intravaginally twice weekly for four to six months Metronidazole, 500 mg orally twice daily for seven days Tinidazole, 1 g orally once daily for five daysĬlindamycin, 300 mg orally twice daily for seven daysĬlindamycin (Cleocin Ovules), 100 mg intra-vaginally at bedtime for three days ![]() Tinidazole (Tindamax), 2 g orally once daily for two days Metronidazole 0.75% gel (Metrogel), one full applicator (5 g) intravaginally daily for five daysĬlindamycin 2% cream, one full applicator (5 g) intravaginally at bedtime for seven days † Metronidazole (Flagyl), 500 mg orally twice daily for seven days * Purulent vaginal discharge, burning, dyspareunia Inflammation thin, friable vaginal mucosa Thin, clear discharge vaginal dryness dyspareunia itching Should be screened for other sexually transmitted infections Green or yellow, frothy discharge foul odor vaginal pain or soreness White, thick, cheesy, or curdy discharge vulvar itching or burning no odor Increased risk of HIV, gonorrhea, chlamydia, and herpes infectionsĬandida albicans, can have other Candida species Inflammatory vaginitis may improve with topical clindamycin as well as steroid application.Īnaerobic bacteria (Prevotella, Mobiluncus, Gardnerella vaginalis, Ureaplasma, Mycoplasma)įishy odor thin, homogenous discharge that may worsen after intercourse pelvic discomfort may be present Atrophic vaginitis is treated with hormonal and nonhormonal therapies. ![]() Treatment of noninfectious vaginitis should be directed at the underlying cause. Trichomoniasis is treated with oral metronidazole or tinidazole, and patients' sex partners should be treated as well. The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for the diagnosis of trichomoniasis in symptomatic or high-risk women. Treatment of vulvovaginal candidiasis involves oral fluconazole or topical azoles, although only topical azoles are recommended during pregnancy. Culture can be helpful for the diagnosis of complicated vulvovaginal candidiasis by identifying nonalbicans strains of Candida. The diagnosis of vulvovaginal candidiasis is made using a combination of clinical signs and symptoms with potassium hydroxide microscopy DNA probe testing is also available. Bacterial vaginosis is treated with oral metronidazole, intravaginal metronidazole, or intravaginal clindamycin. Newer laboratory tests that detect Gardnerella vaginalis DNA or vaginal fluid sialidase activity have similar sensitivity and specificity to Gram stain. Bacterial vaginosis is traditionally diagnosed with Amsel criteria, although Gram stain is the diagnostic standard. ![]() Diagnosis is made using a combination of symptoms, physical examination findings, and office-based or laboratory testing. Noninfectious causes, including atrophic, irritant, allergic, and inflammatory vaginitis, are less common and account for 5% to 10% of vaginitis cases. ![]() Bacterial vaginosis is implicated in 40% to 50% of cases when a cause is identified, with vulvovaginal candidiasis accounting for 20% to 25% and trichomoniasis for 15% to 20% of cases. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis. Vaginitis is defined as any condition with symptoms of abnormal vaginal discharge, odor, irritation, itching, or burning.
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